Family-centered postnatal training and adherence to newborn care practices in district hospitals in two Indian states: A quasi-experimental intervention study

Background and Objectives: Globally, 2.5 million newborns die within the first month of life annually. The majority of deaths occur in low- and middle-income countries (LMICs), and many of these deaths happen at home. The study assessed if the Care Companion Program (CCP) an in-hospital, skills-based training given to families improves post-discharge maternal and neonatal health outcomes. Methods: This quasi-experimental pre-post intervention study design compared self-reported behavior and health outcomes among families before and after the CCP intervention. Intention to treat analysis included families regardless of their exposure to the intervention. Mixed effects logistic regression model, adjusted for confounders, was fit for all observations. Effects were expressed as Relative Risks (RR) with 95% Confidence Intervals (CI). Results: At 2-weeks post-delivery, telephone surveys were conducted in the pre (n = 3510) and post-intervention (n = 1474) groups from 11 district hospitals in the states of Karnataka and Punjab. The practice of dry cord care improved significantly by 4%, (RR = 1.04, 95%CI [1.04,1.06]) and skin to skin care by 78% (RR=1.78, 95%CI [1.37,2.27]) in the post-intervention group as compared to pre-intervention group. Furthermore, newborn complications reduced by 16% (RR=0.84, 95%CI [0.76,0.91]), mother complications by 12% (RR=0.88, 95%CI [0.79,0.97]) and newborn readmissions by 56% (RR=0.44, 95%CI [0.31,0.61]). Outpatient visits increased by 27% (RR=1.27, 95%CI [1.10,1.46]). However, outcomes of breastfeeding, mothers diet, hand-hygiene, and process indicator of being instructed on warning signs were not different. Conclusion: Postnatal care should incorporate pre-discharge multi-pronged training of families to improve essential maternal and newborn care practices. The CCP model runs on a public-private partnership and is integrated into existing health systems. Our findings demonstrate that it is possible to improve outcomes through a family-centered approach in India. The CCP model can be integrated into formalised hospital processes to relieve overburdened healthcare systems in LMIC settings.

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Cost-effectiveness of the Yashoda Programme

Journal of Health Management ◽

10.1177/0972063417699688 ◽

2017 ◽

Vol 19 (2) ◽

pp. 255-263 ◽

Cited By ~ 1

Author(s):

Somen Saha ◽

Beena Varghese

Keyword(s):

Cost Effectiveness ◽

Incremental Cost ◽

Neonatal Mortality ◽

Intervention Group ◽

Newborn Care ◽

Additional Cost ◽

Potential Cost ◽

Neonatal Deaths ◽

District Hospitals ◽

Care Practices

Background: Under the Norway-India Partnership Initiative (NIPI), a pilot programme was launched in 2008 to improve the quality of institutional maternal and neonatal care through Yashodas or birth companions. Yashodas were placed at higher-level healthcare facilities across select districts of India to support mother and newborn. This article presents the additional cost of the Yashoda programme from a government perspective and models the potential cost-effectiveness of the Yashoda intervention in averting neonatal deaths. Methods: We estimated the additional costs of the Yashoda programme (2011–2012) using an activity-based costing approach from a provider perspective. Effectiveness measure was estimated as the difference in the average rate of receipt of counselling (for mothers who delivered at district hospitals) between intervention and comparison districts. The potential impact of the Yashoda programme on neonatal mortality was modelled from secondary data assuming a 30 per cent reduction in neonatal mortality among those who received counselling and practiced safe newborn care practices. Results: The additional cost of Yashoda intervention was US$26,350 per year or US$0.83 per live birth. Eighty-four per cent of mothers in the intervention group received essential postpartum newborn care counselling at the facility compared to 62 per cent of mothers in the comparison groups. Through potential change in newborn care practices, the Yashoda intervention was estimated to avert 45 neonatal deaths for a hypothetical cohort of 100,000 mothers who delivered at district hospitals. The incremental cost of the Yashoda intervention was US$1,832 per neonatal death averted or US$29 per life year saved (LYS). Sensitivity analysis showed the incremental cost per LYS of the Yashoda intervention varied between US$14 and US$59. Conclusion: This study concludes that the Yashoda intervention, when scaled up at high delivery load facilities, is a very cost-effective intervention to save newborn lives.

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The Effect of a Decision-Support mHealth Application on Maternal and Neonatal Outcomes in Two District Hospitals in Rwanda: Quasi-Experimental Study

10.21203/rs.3.rs-79352/v1 ◽

2020 ◽

Author(s):

Aurore Nishimwe ◽

Latifat Ibisomi ◽

Marc Nyssen ◽

Daphney Nozizwe Conco

Keyword(s):

Decision Support ◽

Post Partum ◽

Neonatal Resuscitation ◽

Newborn Care ◽

Neonatal Outcomes ◽

P Value ◽

Post Intervention ◽

District Hospitals ◽

Quasi Experimental ◽

Maternal And Neonatal Outcomes

Abstract Background: Globally, mobile health (mHealth) applications are known for their potential to improve healthcare providers’ access to relevant and reliable health information. Besides, electronic decision support tools, such as the Safe Delivery mHealth Application (SDA), help to reduce clinical errors and to ensure quality care at the point of service delivery. The current study assessed the effects of the SDA on basic emergency obstetric and newborn care (BEmONC) outcomes for the most frequent complications in Rwanda; post-partum haemorrhage (PPH) and newborn asphyxia and its complications.Methods: The study adopted a quasi-experimental design. A pre-intervention record review of the BEmONC outcomes: Apgar score and PPH progressions, was conducted. The intervention took place in two district hospitals in Rwanda and entails the implementation of the SDA for six months. Six months’ post-intervention, the effect of the SDA on BEmONC outcomes was evaluated. The study included 327 participants (114 cases of PPH and 213 cases of neonatal complications). The analysis compared the outcome variables between the baseline and the endline data. Fisher’s exact test was used to compare the proportions and test between-group differences and significance level set at p<0.05. Results: Unstable newborn outcome following neonatal resuscitation was recorded in 61.90% and 27.59% newborns cases at baseline and endline respectively, P-value = 0.000. Unstable maternal outcome following PPH management was recorded in 19.40 % and 6.38% maternal cases at baseline and endline respectively, P-value = 0.048. There was a significant association between the SDA intervention and newborns’ and maternal’ outcomes following neonatal resuscitation and PPH management, 6 months after baseline.Conclusion: The use of the SDA supported nurses and midwives in the management of PPH and neonatal resuscitation thus improved maternal and neonatal outcomes after 6 months of the SDA intervention.

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The Effect of a Decision-Support mHealth Application on Maternal and Neonatal Outcomes in Two District Hospitals in Rwanda: Quasi-Experimental Study

10.21203/rs.3.rs-62197/v1 ◽

2020 ◽

Author(s):

Aurore NISHIMWE ◽

Latifat IBISOMI ◽

Marc NYSSEN ◽

Daphney NOZIZWE CONCO

Keyword(s):

Decision Support ◽

Post Partum ◽

Neonatal Resuscitation ◽

Newborn Care ◽

Neonatal Outcomes ◽

P Value ◽

Post Intervention ◽

District Hospitals ◽

Quasi Experimental ◽

Maternal And Neonatal Outcomes

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Effects and Responsiveness of a Multicomponent Intervention on Body Composition, Physical Fitness and Leptin in Overweight/Obese Adolescents

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147267 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7267

Author(s):

Leticia Borfe ◽

Caroline Brand ◽

Letícia Schneiders ◽

Jorge Mota ◽

Claudia Cavaglieri ◽

...

Keyword(s):

Body Composition ◽

Physical Fitness ◽

Intervention Group ◽

Interleukin 10 ◽

Control Group ◽

Post Intervention ◽

Necrosis Factor Alpha ◽

Obese Adolescents ◽

Quasi Experimental ◽

Multicomponent Program

Physical exercise reduces the biochemical markers of obesity, but the effects of multicomponent interventions on these markers should be explored. The present study aimed to elucidate how overweight/obese adolescents respond to a multicomponent program approach on body composition, physical fitness, and inflammatory markers, using a quasi-experimental study with 33 overweight/obesity adolescents (control group (CG) = 16; intervention group (IG) = 17). The intervention consisted of 24 weeks with physical exercises and nutritional and psychological guidance. Both groups were evaluated at the pre/post-intervention moments on body mass index (BMI); body fat (%Fat); waist circumference (WC); waist/hip ratio (WHR); waist-to-height ratio (WHtR), cardiorespiratory fitness (CRF); abdominal strength, flexibility; leptin; interleukin 6; interleukin 10; and tumor necrosis factor-alpha. Mixed-analysis of variance and generalized estimation equations were used for statistical analysis. There was an interaction effect between groups and time on %Fat (p = 0.002), WC (p = 0.023), WHR (p < 0.001), WHtR (p = 0.035), CRF (p = 0.050), and leptin (p = 0.026). Adolescents were classified as 82.4% responders for %Fat, 70.6% for WC, 88.2% for WHR, and 70.6% for CRF. Further, there was an association between changes in %Fat (p = 0.033), WC (p = 0.032), and WHR (p = 0.033) between responders and non-responders with CRF in the IG. There was a positive effect on body composition, physical fitness, and leptin. In addition, reductions in body composition parameters were explained by CRF improvements.

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1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1528 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S684-S684

Author(s):

Victoria Konold ◽

Palak Bhagat ◽

Jennifer Pisano ◽

Natasha N Pettit ◽

Anish Choksi ◽

...

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Intervention Group ◽

Post Intervention ◽

Days Of Therapy ◽

New Antibiotics ◽

Core Elements ◽

Quasi Experimental ◽

Empirical Antibiotics ◽

The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

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Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study

Implementation Science ◽

10.1186/s13012-020-01058-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Karen Zamboni ◽

Samiksha Singh ◽

Mukta Tyagi ◽

Zelee Hill ◽

Claudia Hanson ◽

...

Keyword(s):

Quality Improvement ◽

Neonatal Mortality ◽

Process Evaluation ◽

Andhra Pradesh ◽

Newborn Care ◽

Mechanisms Of Change ◽

Evidence Based ◽

Programme Implementation ◽

Quasi Experimental ◽

Care Practices

Abstract Background Improving quality of care is a key priority to reduce neonatal mortality and stillbirths. The Safe Care, Saving Lives programme aimed to improve care in newborn care units and labour wards of 60 public and private hospitals in Telangana and Andhra Pradesh, India, using a collaborative quality improvement approach. Our external evaluation of this programme aimed to evaluate programme effects on implementation of maternal and newborn care practices, and impact on stillbirths, 7- and 28-day neonatal mortality rate in labour wards and neonatal care units. We also aimed to evaluate programme implementation and mechanisms of change. Methods We used a quasi-experimental plausibility design with a nested process evaluation. We evaluated effects on stillbirths, mortality and secondary outcomes relating to adherence to 20 evidence-based intrapartum and newborn care practices, comparing survey data from 29 hospitals receiving the intervention to 31 hospitals expected to receive the intervention later, using a difference-in-difference analysis. We analysed programme implementation data and conducted 42 semi-structured interviews in four case studies to describe implementation and address four theory-driven questions to explain the quantitative results. Results Only 7 of the 29 intervention hospitals were engaged in the intervention for its entire duration. There was no evidence of an effect of the intervention on stillbirths [DiD − 1.3 percentage points, 95% CI − 2.6–0.1], on neonatal mortality at age 7 days [DiD − 1.6, 95% CI − 9–6.2] or 28 days [DiD − 3.0, 95% CI − 12.9—6.9] or on adherence to target evidence-based intrapartum and newborn care practices. The process evaluation identified challenges in engaging leaders; challenges in developing capacity for quality improvement; and challenges in activating mechanisms of change at the unit level, rather than for a few individuals, and in sustaining these through the creation of new social norms. Conclusion Despite careful planning and substantial resources, the intervention was not feasible for implementation on a large scale. Greater focus is required on strategies to engage leadership. Quality improvement may need to be accompanied by clinical training. Further research is also needed on quality improvement using a health systems perspective.

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Self-Care Options for Resilient Educators (SCORE) Teaches Aspiring Teachers How to Manage Stress in Light of COVID-Related Disruptions

OBM Integrative and Complementary Medicine ◽

10.21926/obm.icm.2104039 ◽

2021 ◽

Vol 06 (04) ◽

pp. 1-1

Author(s):

Brandis M. Ansley ◽

◽

Meagan A. Wander ◽

Keyword(s):

Stress Management ◽

Comparison Group ◽

Secondary Trauma ◽

Intervention Group ◽

Self Care ◽

Management Training ◽

Medium Effects ◽

Post Intervention ◽

Stress Management Training ◽

Quasi Experimental

Self-Care Options for Resilient Educators (SCORE) is an 8-week, asynchronous virtual training program that teaches stress management skills relevant to educators’ job-related responsibilities and interpersonal interactions. From January-April 2020, 28 pre-service teachers participated in a quasi-experimental study of SCORE’s feasibility and preliminary efficacy. Volunteers chose to either complete SCORE concurrent with their teaching internship or to complete the same assessments for comparison purposes. Recruitment and implementation took place prior to COVID-19 disruptions. Then, six weeks into SCORE, the participants encountered unanticipated school closures and uncertainties associated with their internships (e.g., Would they be able to complete their internships and degree programs? Would they be eligible to teach the next school year?). Despite disruptions to their teaching internships, the remote format of SCORE allowed the study to continue and for participants to complete the full training. Pre-intervention to post-intervention changes in outcomes for the intervention group reflected large effect sizes for decreases in burnout and increases in teacher efficacy. There were medium effects for increased self-compassion and small-to-medium effects for increased cognitive reappraisal. However, pre-to-post intervention differences for the comparison group were relatively unchanged on most indicators. Results for secondary traumatic stress was remarkable, as the comparison group demonstrated a medium-to-large effect for an increase at post-intervention. This measure, however, revealed no effect in change for program participants. This finding is noteworthy and suggests that participation in SCORE or a similar program may help mitigate the potentially harmful effects of exposure to secondary trauma. Overall, this study’s results support arguments for including stress management training during pre-service teaching internships.

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Perceptions of caregivers on immunization in Ntungamo district, Uganda

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20214559 ◽

2021 ◽

Vol 8 (12) ◽

pp. 5729

Author(s):

Byamukama Topher ◽

Keraka M. Margaret ◽

Gitonga Eliphas

Keyword(s):

Risk Factor ◽

Intervention Group ◽

Cost Effective ◽

Systematic Sampling ◽

Control Group ◽

Post Intervention ◽

Mortality And Morbidity ◽

Significant Difference ◽

Quasi Experimental ◽

And Control

Background: Immunization is one of the most cost-effective public health interventions to reduce child mortality and morbidity associated with infectious diseases. The objective of this study was to determine the perceptions of caregivers on immunization in Ntungamo district.Methods: Quasi-experimental study was used with health centres assigned to intervention and control groups. Purposive sampling was used to select the two counties where the study was done. Proportional sampling was done to get study samples from each health facility, while systematic sampling was done to get study participants. A total of 787 children from twelve health facilities provided the study sample. A post intervention evaluation was conducted to determine the effect of these interventions. Association of variables was tested using Mann Whitney U-test and Chi-square.Results: On benefits, most caregivers in the intervention group (85.3%) and in the control group (54.3%) regarded immunization as very highly and moderately beneficial to their children respectively. On risks, most caregivers in the intervention group (85.5%) and control group (43.1%) regarded the risk factor associated with immunization as very low and moderate respectively. From hypothesis testing, there was a significant difference on the perceived benefits and risks of immunization between the intervention and control group.Conclusions: Most caregivers in the intervention and control group regarded immunization as very highly beneficial and moderately to their children respectively. Most of the caregivers in the intervention and control group regarded the risk factor associated with immunization as very low and moderate respectively.

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The Effectiveness of the Use of Nurse Safety Booklet on Nurse Knowledge in Ergonomic Injury Prevention in BIMA Hospital

International Journal of Studies in Nursing ◽

10.20849/ijsn.v4i2.578 ◽

2019 ◽

Vol 4 (2) ◽

pp. 108

Author(s):

A. Haris ◽

Abdul Haris

Keyword(s):

Health Services ◽

Intervention Group ◽

Hospital Staff ◽

Control Group ◽

P Value ◽

Research Subjects ◽

Post Intervention ◽

Quasi Experimental ◽

The Difference ◽

Nurse Knowledge

Safety has become a global issue in various sectors, including the health services sector. The hospital is one of the health service organizations that is guided to continuously improve quality by building safer and safer health services so as to get customer loyalty. Hospital staff is a major component of quality management in one of the indicators in evaluating hospital accreditation. This research uses a quasi-experimental research design pre and posttest with control group. Quasi experiment research is a study that tests an intervention in a group of research subjects and then measures the results of the intervention. Samples in this study are all nurses who are in the room of the General Hospital, Surgery and ICU Bima Hospital, which are 50 people. The results showed the results of different tests using paired t-test p value = 0.000 which can be concluded that there are differences between the intervention group and the control group, seen from the value of the difference in the intervention group is greater than the difference in the control group can be interpreted as education using more booklets affect the increase in nurse knowledge. The conclusion in this study was that there were significant differences in nurses' knowledge after being given education using pre and post intervention booklets between the intervention and control groups (p = 0.000).

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Effectiveness of an Educational Intervention to Participation in Physical Activity: A quasi-experimental model-based study

10.21203/rs.2.22356/v1 ◽

2020 ◽

Author(s):

Saeideh Shahsavari ◽

Sakineh dadipoor ◽

Mohtasham Ghaffari ◽

Ali Safari-Moradabadi

Keyword(s):

Physical Activity ◽

Educational Intervention ◽

Stages Of Change ◽

Intervention Group ◽

T Test ◽

Control Group ◽

Post Intervention ◽

Chi Square ◽

Significant Difference ◽

Quasi Experimental

Abstract Background: The aim of the present study was to assess readiness to become or stay physically active according to the Stages of Change Model.Methods: The present quasi-experimental study was conducted on 100 women working in the healthcare centres of Bandar Abbas, Iran. The sampling method is clustering in type. The subjects were assigned into two groups of intervention and control. The collected data were analysed by SPSS-16 software using descriptive and inferential statistics, including independent-sample t-test, paired-sample t-test and Chi-square test.Results: Before the educational intervention, 19 subjects (0.38%) from the intervention group showed to have regular physical activity (4-5 stages). This number changed to 29 (0.58%) and 25 (0.50%) after three months and six months of intervention. A statistically significant difference was found before the intervention and 3 and 6 months afterwards (P˂.001). In the control group, no statistically significant difference was found between the pre-intervention and post-intervention (three months (P=.351) and six months (P=.687).Conclusion: The educational intervention based on the stages of behaviour change model showed to be effective in promoting the physical activity of employed women. These findings may benefit health education researchers and practitioners who tend to develop innovative theory-based interventions and strategies to increase the level of physical activity in women.

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